Background & objectives:Hyperosmolar hyperglycaemic state (HHS) is a medical emergency, but there is a paucity of studies reporting the spectrum of neurological manifestations of HHS. We, therefore, report the neurological spectrum, triggering factors and outcome of HHS in general neurology practice.Methods:The records of the patients with HHS were extracted from computerized hospital information system and those managed currently were prospectively included. The demographic, clinical manifestations, duration of diabetes and precipitating events such as infection, stress and stroke were noted. Patients with HHS were categorized into seizure, movement disorder and encephalopathy groups. Their electroencephalography, magnetic resonance imaging (MRI) findings and outcome were noted.Results:There were 17 patients with HHS (age range 40 and 75 yr) and seven were females. Seven patients were diabetic for five years, one for four years, one for one year and four were diagnosed after the occurrence of HHS. Four patients had epilepsia partialis continua persisting for 72-360 h, one patient had focal seizures and his MRI revealed T2 hyperintensity in frontal region in one patient and cerebellar vermian hyperintensity in another. All the five patients improved, but two had neurological deficits on discharge. Nine patients had encephalopathy which was precipitated by stroke in six patients, urinary infections in two and meningitis in one. Three females had hemichorea-hemiballismus syndrome, which was triggered by infections. Abnormal movements lasted 5-10 days and responded to correction of hyperosmolarity. Nine out of 17 patients improved completely whereas the remaining eight had partial recovery, these patients had stroke, ventilator-related complications or meningoencephalitis.Interpretation & conclusions:The most common presentation of HHS was encephalopathy (9) followed by seizure (5) and hemichorea-hemiballismus syndrome (3) which responded to the correction of hyperosmolar state.

Objective:There is paucity of reports on thyrotoxic periodic paralysis (TPP) from India. We report the patients with TPP and compare them with idiopathic hypokalemic periodic paralysis (IHPP).Materials and Methods:Patients with hypokalemic periodic paralysis (HPP) treated during the past 11 years were evaluated retrospectively. Their demographic parameters, family history, clinical features, precipitating factors, severity of weakness, laboratory parameters and rapidity of recovery were recorded. The demographic, clinical and laboratory parameters of TPP and IHPP were compared.Results:During the study period, we managed 52 patients with HPP; nine (17.3%) of whom had TPP and 27 (52%) had IHPP. The demographic, precipitating factors, number of attacks and severity of limb weakness were similar between the TPP and IHPP groups, except in the IHPP group, bulbar weakness was present in four and respiratory paralysis in six, needing artificial ventilation in two patients. Serum potassium was significantly lower in TPP (2.21 ± 0.49) compared with IHPP (2.67 ± 0.59, P = 0.04). Four patients with TPP had subclinical thyrotoxicosis and two had subclinical hyperthyroidism. Rebound hyperkalemia occurred in both TPP and IHPP (three versus eight patients). The recovery was faster in IHPP (26.7 ± 15.4 h) compared with TPP (34.0 ± 14.0 h), but was statistically insignificant.Conclusion:TPP constitutes 17.3% of HPP, and absence of clinical features of thyrotoxicosis and subclinical hyperthyroidism in TPP is not uncommon. Clinical features, demographic profile and rebound hyperkalemia are similar in both TPP and IHPP. The serum potassium level is significantly low in the TPP compared with the IHPP group.

Hashimoto's encephalopathy (HE) is a rare autoimmune encephalopathy occurring in patients with thyroid disorder with diverse clinical manifestations. They have elevated serum antithyroid antibodies with or without thyroid dysfunction. Early diagnosis and treatment with immunomodulating drug may result in complete recovery. We have managed five patients with HE in last 11 years (Table 1). We report these patients and highlight the clinical spectrum and response to treatment. Case detailsFive patients with HE were managed one was male, they were aged between 47 and 54 years. Four patients were clinically hypothyroid; one had subclinical hypothyroidism and three patients were on thyroxine replacement. The duration of symptoms ranged between 2 days and 8 months.The clinical spectrum included encephalopathy in 3 (dementia in 1, agitation ataxia in 2) and stroke-like illness in two patients. Generalized tonic-clonic seizure was present in three patients. Abnormal movements included head tremor and myoclonic jerks in one patient each. ESR was elevated in all (30-67 mm/1st h). Blood sugar was normal and serum creatinine was transiently elevated on admission in two patients, but became normal after correction of dehydration and control infection. CSF revealed high protein in 4 (49-264 mg/dL) and stroke-like illness patient had 20 cells/ mm 3 . CSF was not done in patients with intracerebral hemorrhage. MRI revealed T2 hyperintensities in basal ganglia and temporal lobe in patient #4, in frontal region in strokelike patients. CT scan showed right putaminal hemorrhage in one and normal in two patients. EEG revealed diffuse theta to delta slowing in 4 out of 5 patients and patient #5 had low voltage complex in ECG (Fig. 1). SPECT was done in patient #1 and was normal. Patients responded well to intravenous methyl prednisolone and L-thyroxine and other supportive treatment. Patient #5 developed refractory hypotension which responded to hydrocortisone. On followup three were independent and two were dependent for ADL because of stroke-like illness (Table 1). DiscussionOur study of five patients with Hashimoto encephalopathy (HE) has revealed that three patients presented with encephalopathy comprising behavioral abnormality, dementia and altered sensorium with myoclonic jerks, tremors, seizures and ataxia. Two patients presented with stroke-like illness. This is consistent with the reported clinical spectrum of HE. A review of 85 patients with HE also reported female preponderance (81 %), with two major types of clinical presentation; stroke-like illness in 27 % with transient focal neurologic deficit with or without seizures. The encephalopathic form manifests with dementia, psychosis and coma without focal neurological deficit. Seizures occur in 66 %, myoclonus in 38 %. It has a relapsing-remitting course in 60 % [1,2].HE has variable onset ranging from days to years concurrent infection may unmask or precipitate HE. These patients may have high CSF protein 48-298 mg % in up to

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Neurological disorder is state of physical as well as mental damage. Neurological disorders begin with significant limitation of intellect or cognition and poor adaptation to the demands of every day of life. The purpose of the present study is to observe the feeding pattern and meal managements of selected hospitalised patients. 150 Neurological Disorder patients were selected from the different hospitals of Raipur city, Chhattisgarh, India. A pre tested individuals data sheet (IDA) was used to collect the information's regarding feeding Behaviour feeding difficulties of neurological patients. The result of the present study Reveals that feeding problems are extremely common (75 %) among the (ND) Patient. The study recommends such types of patients should be monitored properly. Feeding problems of such patients should be treated as early as possible, so that patient can grow physically and neurologically well.